I’ve always been disturbed by the idea of transgender surgery, and of surgery relating to appearances in general. Part of it is because surgery is generally icky, part is because it’s objectively dangerous, and part is because there are doubts about how effective it is at helping us to deal with our transgender feelings. There are situations where most of us would agree that surgery is ineffective or not worth the risk. I’ve met some people – trans and not trans, of all genders – with facial features that are clearly artificial, unattractive, and worse-looking than if they had just left things the way they were.
Surgery is also expensive. This means that making cosmetic surgery the norm – whether for trans people or for large segments of the population at large, as I’ve heard it is in places like California, Korea and Venezuela – gives an advantage to people who can better afford it.
While I have no interest in getting any such surgery, there are a few things that have made me more comfortable with the idea for other people, and in general.
The first was a discussion I had with some friends in grad school. One guy told a story about a time when he was driving home from work late at night, overtired, and blacked out and hit a telephone pole. The impact split his face open, but surgeons were able to reconstruct it. I was shocked, because I had no idea that anything had happened to him. He told me that his beard helped to hide the scars. At that point I realized the value of that kind of surgery: it had spared him a lifetime of disfigurement.
Another was the realization that I have in fact had cosmetic facial surgery, on a small scale. In the past I’ve been complimented for having a youthful, feminine face, but I thought that was all luck of the genes. Then one day I read that the width of a person’s mouth is a major factor when people judge a face to be a man’s or a woman’s.
When I was a kid I had crooked teeth, basically because there wasn’t enough room in my mouth for all of my teeth. When I was fifteen my mom took me to get braces, but my orthodontist said that before he put them on I had to get four bicuspids removed so that all the teeth could line up. So he sent me to an oral surgeon. It’s certainly not what most people think of as surgery: the procedure took about an hour, and the anesthetic was just a relatively high dose of novocain. (The oral surgeon offered me a valium, but I declined.) But removing four large, healthy adult teeth and then sewing up the gums was a fairly major procedure for dental work.
If I had not had those teeth removed, I would probably have had to have my wisdom teeth removed a few years later, but all my teeth together would probably also have taken up more space, giving me a wider mouth and a more masculine appearance, and maybe even making my jaw grow bigger than it has. So I believe the result was some permanent facial … not exactly “feminization,” but anti-masculinization.
As I said, surgery is generally icky, and dangerous, but there are some times when it is clearly life-saving, like an appendectomy. I think most of us can agree that it was also good that surgeons were able to reconstruct my grad school friend’s face so that people didn’t grimace when they saw him. On the other hand, even in circumstances like those there are people who would not care about the grimacing and would choose the minimum amount of surgery to be able to physically function, and forgo anything beyond that.
It is important to recognize that when people choose to have cosmetic surgery, they are often not acting rationally. They may be under a mistaken belief that the surgery will satisfy a glamour longing that they feel. They may be addicted to the danger, or to the excitement of a new image. Their minds may be clouded by gender fog. Many people are not well-informed of the risks of surgery – even the simple risk that what they get may not look very good, or may not age well.
The bottom line is that adults should be free to choose what kind of surgery is done to modify their bodies, and children should be allowed to make reasonable modifications that they are not likely to regret in the future. Part of living in a free country is giving people the freedom to act irrationally, or in rational ways that are beyond our understanding.